Last month the Office of National Statistics updated its national population projections, estimating 78 million people living in the UK over the next 25 years. This represents just over an eight million person increase. Therefore, a rethink about what our health system looks like, and the resilience and the preparedness of a future model is needed.
Our health care system in the UK is built on a complex network of care processes and pathways. Our view is that it is buckling under the pressure and struggling to respond to the demand and changing population needs. The quality of care within our system depends on how well this network functions, and the connection and integration of the multiple microsystems that make up this complex web of health service provision.
What we can all agree on, irrespective of political alignment and ideology, is the shared vision and aim of our health service to provide high quality care to patients and to improve the health and wellbeing of our population. From a systems perspective, the collective vision is present. So, what is causing the disruption, backlog and fault lines within our NHS?
Here at MPM Health, we recognise like anyone within the system will tell you, there are some great processes and pathways that operate and work really well; but for every one that works well, there are many others that just do not step up to the mark. This leads to delays, missed opportunities and frustrations, but more importantly causing harm and contributing to morbidity and mortality rates.
In our last article, we identified 10 key challenges and focus areas we think are necessary for transforming the UK health service. In this article we are looking at the here and now, and what we believe are the fundamentals for reforming and re-shaping our current model, and how that will set the foundations for the future. It is our opinion, where we believe quality improvement methodology and processes offer the biggest value.
Quality Improvement
The fundamentals of quality improvement lie with those closest to the problems and issues that are impacting care. They are the experts, and can identify barriers and potential solutions, from real life and lived experiences. This is not new, and for years we have seen value-based departments pop up, innovation teams launch, and transformation plans appear but not deliver, and along with it millions of pounds in public money wasted, lost hours, and in particular, lost clinical hours, and with it the last remaining energy, hope and passion of the staff and public confidence.
We recognise that for change to happen, teams need resources, money and time. But for us, the most important ingredient is power and control, and how they are positioned to facilitate the development and testing of de novo solutions and for implementing change.
Quality improvement, innovation and change are all transformations looking to disrupt the status quo and evolve to new ways of doing, thinking or organising. With change comes resistance and challenge from dominant institutional arrangements, powerful individuals or cultural and societal norms that have transcended centuries. This makes health transformation and quality improvement very challenging, as the complex system can be both a facilitator and a barrier to change and the power and control within and between systems hard to identify, isolate and address; given the highly intertwined and complex system health operates in.
Power and control dynamics are the crucial factor and for many years have been dominated by hierarchical structures, authoritative decision making and ivory tower us-and-them separation. Areas such as business, have moved beyond such stringent and repressive structures and adopted a purpose-driven approach. This places significant focus on the ‘why’ and to progress under a collective responsibility and accountability, but more importantly a powered position to influence and instigate change where needed.
We are working with leading companies and providers who are transcending the norm and pushing boundaries to deliver a human-centred and mission-orientated approach. We work with teams who have the delegated authority to work to improve the standard of care and to develop and bring to fruition innovation and change. Not only novel ideas and concepts, but also shared learning and systems from other sectors and areas of the world that can be adapted and applied to the UK health system.
Innovative health solutions locally delivered
MPM Health brings the very best in global innovation to patients across Europe (starting with Wales and the rest of the UK). We are working with world leading scientists and engineers who are pioneering tools and technology to improve physical and mental health outcomes, and the wellbeing of people, whilst reducing health inequalities within and across populations. MPM Health and its partners use a data-driven, human centred planning approach which allows us to work with clinical teams to identify those most at risk and match these needs with new and innovative technologies that are otherwise inaccessible. Allowing us to support clinical teams to deliver pro-active care and achieve maximum impact for the health and wellbeing for each patient.
MPM Health is a trusted partner bringing care closer to home, supporting the delivery of the right care, at the right time, using the right resource; by delivering the solutions to the system issues. This affords clinical teams the time, space and energy to focus on delivering high quality, personalised health care, through a population health lens that considers the wider determinants interpretation of health.
The ’why’ behind the actions
We support teams in making this a reality. We do this by facilitating conversations and listening to the problems, and engaging in a solution focussed discussion to explore their ideas, solutions and the ‘blue sky thinking’. We then set to work to match these expectations and desires with emerging and developed innovative health and AI supportive solutions from our global partners. Bringing the very best in global technology to teams right here in the UK.
Executed well, quality improvement can lead to:
- Increased quality of service delivery
- Increased patient experience
- Increased staff satisfaction
- Improved access to care
- Reduction in health inequalities
- Optimised treatment planning, and
- Prudent health care delivery
Our mission is simple: to provide precision medicine and person-centred care, allowing care closer to home and with patients more in control and involved in their treatment planning. We are a patient-centric company that supports our partners to deliver innovative and evidence-based practices for the health and wellbeing of the patients they see, increasing patient-clinician interaction, reducing workforce demand and improving patient experiences.
We are proud to be working with our partners to understand the challenges and limitations of their current model of delivery. By collectively working across and within the layers of the system, we unpick the social make-up and construction of the system, contextualise the issues to identify leverage points that are maintaining the status quo, and re-imagine the system to fundamentally shift the power and control dynamics. This supports the implementation of new ways of working and new technology to enhance the service delivery and end-user experience, leading to transformative health care.
To survive and succeed, every organisation will have to turn itself into a change agent.
Our approach is to support teams embarking on this transformative journey, to collectively re-imagine the ‘why’ and progress a purpose-driven approach to care quality, that is based on adapted dimensions of the Department of Health and Social Care single view of care quality:
MPM Health’s purpose-driven care quality dimensions
Safe: Avoiding harm to patients but also to the staff involved in their diagnosis and treatment, including reducing human error and improving quality assurance.
Effective and Evidence Based: Providing services based on evidence that produces a clear benefit. Taking a de-colonised view of evidence and use of knowledge mobilisation from around the world.
Caring and Responsive: Staff treat people through a person-centred lens, responding to their needs and choices, and co-producing treatment plans. Ensuring patients are empowered to make informed decisions and active agents in their care.
Compassionate and Competent Leadership: Well-led systems by capable and qualified individuals who are driven by compassionate leadership and can champion collective and progressive team values; striving to create a system that is open and collaborative, both internally and externally.
Sustainable and Equitable: They use resources responsibly and efficiently, providing fair access to all, and according to the needs of the population. Improving access and reducing inequalities across people and places, adopting a proactive preventative approach and solution focused frameworks to support the default ‘yes’ position.
Measurable, Adaptable and Accountable: Focused on data, both qualitative and quantitative to understand patient journeys and experiences, staff perceptions, clinical efficiencies and outcomes. Continually check fidelity to pathways, processes and evidence-based practices, and implement service improvement plans where deficiencies are found, and accountability is taken and acted on for sub-optimal service delivery and health and wellbeing outcomes. Services, staff and leaders must be committed to learning and improving on a continuous cycle and that it is integrated as part of any audit, transformation or people plan.
Can the NHS shift power and control?
As you are probably aware, the National Health Service (NHS) is the umbrella term for the four health systems of England, Scotland, Wales and Northern Ireland. Each devolved administration has the responsibility which includes the organisational control and funding allocation. Despite what it may look like to the outside world, the similarity remains mainly in name and operational pressures. Although, by and large, there is some degree of decentralisation, the power and control nexus of all four health systems is built on the traditional leadership models of centralised authority, top-down decision making, with power and control for leaders and no power and/or control for staff and services outside of this central command suite, and the same for patients.
We argue that here lies the problem and major challenge for service improvement; to improve health outcomes and turn the tide on some of the wicked health issues and system challenges we are facing. Despite some devolved control within local government and between local governments and other providers, the decision making and the power and control remains centrally positioned. We believe this is stagnating innovation, disengaging staff and leaving our health services responding to the modern-day problems, with yesteryears tools, resources and ideas.
At MPM Health we are working with emerging and disruptive start-up companies that are putting local and closer to home at the heart of care. Driving bold and instinctive ideas that focus on the ‘why’ and focus on meaningful missions to drive down cost, improve access and provide quicker and better options at our disposal for improving quality care.
Final words
Our last article talked about what we think are the top 10 challenges that face the NHS and the areas of focus for this year. We think that a central component of these challenges lies in the power and control nexus of what is a large and complex network of people, processes and pathways.
In order to realise the potential and to drive through some of the changes and solutions that we suggested, there needs to be a radical shift in the power and control dynamics, and for a paradigmatic shift from dominant traditional centralised power.
We advocate for trust in the process of relinquishing rigid structures and decision-making vacuums, and to embrace more transformative and purpose-driven models that foster collaborative and shared change and delivery. We argue that it is only when these shifting power and control dynamics are realised, do we start to see the opportunities for change, and for the space and energy for some of the solutions to come from a bottom-up perspective.
Let’s chat
If you work in healthcare please share your thoughts, or if you know someone who does please share this article with them so they can. Maybe you and your team have experience in making changes? How was that process for you? Can you offer your reflections for others? We would love to hear from you.💡 Additional Insights:
National population projections – Office for National Statistics
Purpose-Driven Leadership: Moving Away From Traditional Power Dynamics
3. Power dynamics play a key role in problems and innovation | Pew Research Center